This project will address the hypothesis that assessment of the balance between clot formation and dissolution before, during and after thrombolytic therapy will yield clinically useful information with respect to cardiac and points and hemorrhagic complications. We will utilize the TIMI-II plasma sample repository (n = 2416) to evaluate this hypothesis. Toward this objective we will execute the following studies: 1) Case/control studies to evaluate hemorrhagic events and three separate cardiac endpoints (recurrent non-fatal MI and/or death; clinical reperfusion and/or patency; and increasing post-therapy ischemia). 2) An external comparison study of representative TIMI-II patients with matched normal controls will evaluate hemostatic markers which have promise for usefulness in understanding fundamental mechanisms or diagnosis of evolving acute myocardial infarction. These studies will dissect the molecular events of coagulation and fibrinolysis before, during and after thrombolytic therapy. We believe that this dissection must take place on many fronts since it is unlikely that understanding the role of any single factor will explain atherosclerosis, thrombosis and acute myocardial infarction. Rather, it appears most likely that a comprehensive approach will prove more fruitful.